[Federal Register Volume 59, Number 167 (Tuesday, August 30, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-21290]
[[Page Unknown]]
[Federal Register: August 30, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Community Support Program: Cooperative Agreements for Employment
Intervention Demonstration Program
AGENCY: Center for Mental Health Services, Substance Abuse and Mental
Health Services Administration (SAMHSA), HHS.
ACTION: Notice of availability of funds and request for applications.
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*It is important to note that applications are invited based on
the funding levels proposed in the President's budget for fiscal
year 1995. However, this RFA is being announced prior to an
appropriation of funds in order to allow applicants sufficient time
to establish collaboration and coordination and prepare
applications. Solicitation of applications in advance of an
appropriation will also enable the award of appropriated grant funds
in the most expeditious manner and allow prompt implementation and
evaluation of promising employment intervention programs for adults
with severe mental illnesses. All applicants should understand,
however, that final appropriation action will be necessary in order
for CMHS to fund any applications. Questions regarding the status of
the appropriation of funds should be directed to the program
official listed under Contacts for Additional Information in this
notice.
SUMMARY: The Center for Mental Health Services (CMHS) announces the
availability of demonstration grants to document the effectiveness of
programs designed to enhance competitive employment for adults with
severe mental illnesses. Funds will be awarded through the Community
Support Program (CSP) of the Division of Demonstration Programs of
CMHS. This request for applications (RFA) solicits applications for two
types of awards:
Demonstration Sites and a Coordinating Center.
This demonstration program addresses a priority mental health need:
the enhancement of competitive employment for adults with severe mental
illnesses. A collaborative, multisite approach is essential to test the
effectiveness of different employment interventions and synthesize the
intervention results. Because of the complexity of the program,
requiring substantial programmatic involvement of CMHS staff to
facilitate communication and coordination across projects, the
cooperative agreement mechanism is being used.
This notice consists of three parts:
Part I covers information on the legislative authority and the
applicable regulations and policies related to the Community Support
Program: Cooperative Agreements for Employment Intervention
Demonstration Program.
Part II describes the target population, the issue, and the
programmatic goal and discusses eligibility, availability of funds,
period of support and the receipt date for applications.
Part III describes special requirements of the program, the
application process, the review and award criteria and lists contacts
for additional information.
Part I--Legislative Authority and Other Applicable Regulations and
Policies
Cooperative agreements awarded under this RFA are authorized under
Section 520A of the Public Health Service Act, as amended (42 U.S.C.
290bb-32).
Federal regulations at Title 45 CFR Parts 74 and 92, generic
requirements concerning the administration of grants, are applicable to
these awards.
Grants must be administered in accordance with the PHS Grants
Policy Statement dated April 1, 1994 (DHHS Publication No. (OASH) 94-
50,000 (Rev)). This policy statement is effective for all grants with
budget periods beginning on or after April 1, 1994. It also reflects
policies with earlier effective dates. This document supersedes the PHS
Grants Policy Statement dated October 1, 1990, as updated September 1,
1991.
The Catalog of Federal Domestic Assistance (CFDA) number for this
program is 93.125.
Reporting Requirements: Interim and final progress reports and
financial status reports will be required and specified to awardees in
accord with PHS Grants Policy requirements.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of Healthy People
20001, a PHS-led national activity for setting priority areas.
This RFA, ``Employment Intervention Demonstration Program,'' is related
to the objectives set forth in Chapter 6, Mental Health and Mental
Disorders, in Healthy People 2000: National Health Promotion and
Disease Prevention Objectives.
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\1\Potential applicants may obtain a copy of Healthy People 2000
(Full Report: Stock No. 017-001-00474-0; or Summary Report: Stock
No. 017-001-00473-1) through the Superintendent of Documents,
Government Printing Office, Washington, D.C. 20402-9325 (Telephone:
202-783-3238).
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Part II--Target Population, Issue and the Programmatic Goal and Project
Requirements and Activities, Eligibility and Application Receipt Date
Purpose: The goal of this RFA is the generation of knowledge about
effective approaches for enhancing competitive employment for adults
with severe mental illnesses through support for the implementation and
evaluation of promising employment intervention programs. Applications
are being solicited for Demonstration Sites to conduct a multisite,
cooperative study of employment interventions to enhance competitive
employment. Applications are also being sought for a Coordinating
Center to provide overall coordination and data management and to carry
out the common protocol which will be developed.
Target Population: The population of concern for CSP grants
includes individuals 18 years and older with severe mental illnesses
(including, but not limited to, schizophrenia, schizoaffective
disorders, mood disorders, and severe personality disorders) that
substantially interfere with a person's ability to carry out such
primary aspects of daily living as self-care, household management,
interpersonal relationships, and work or school.
Statement of Issue: Rehabilitation is an essential component of
care for adults with severe mental illnesses. In order to enhance
independent living as fully as possible, rehabilitation services need
to include appropriate vocational rehabilitation, which may include:
assessment of potential for employment, training, job placement,
continuing support, and reasonable accommodations at the work site. In
addition to providing remuneration and social contacts, employment may
promote improvements in self esteem, independence, community
integration, and self-management of illness. People with psychiatric
disabilities are the second largest group of applicants for vocational
rehabilitation services and have the lowest rate of success. Even with
high client motivation and the support of families, rates of employment
for this population are very low, ranging from 10 percent to 25
percent.
Special attention should be focused on persons from ethnic minority
communities who are over-represented in the adult severe mental illness
population. With involvement of these community members at each stage
of design, implementation and evaluation, culturally competent
interventions can be successful.
Program Goal: This demonstration program addresses a priority
mental health need: competitive employment in integrated settings for
adults with severe mental illnesses. Competitive employment is defined
as a paid position which is open to anyone and pays at least minimum
wages. Employment may include positions in a mental health system as
long as the positions are not restricted to adults with diagnoses of
severe mental illnesses. On-site and/or off-site long-term supports may
be utilized. Because there is a need for systematically bringing
together information concerning employment intervention programs, CMHS
is initiating this program to determine the effectiveness of
interventions. Findings concerning the most effective approaches and
the associated direct costs are needed by policy makers and program
planners.
This program of study is focussed on employment interventions which
will lead to competitive employment. The goal of the intervention,
which may include vocational training and environmental accommodations,
must be competitive employment in mainstream (not sheltered) work
environments. Outcome measures may include, but are not limited to,
days of paid employment within a specified time interval, level of
social and occupational functioning, and consumer and employer
satisfaction.2 Effective employment interventions are an integral
part of a community support system and, therefore, are expected to be
integrated with other services as appropriate.
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\2\Technical assistance, provided upon request, will include a
review of instruments prepared by Cook, J., Bond, G., Hoffschmidt,
S., et al., Assessing Vocational Performance Among Persons with
Severe Mental Illness, published by Thresholds National Research and
Training Center, Chicago, IL: 1992.
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The goals of this program address the themes of the Secretary of
HHS: fostering independence through empowering people served;
preventing future problems; and improving services to customers through
modern management approaches.
Demonstration Site applicants will develop, implement, and evaluate
an intervention with the goal of improving competitive employment. This
multisite, cooperative agreement will also develop a common study
protocol. After grantees are selected for funding, grantees and CMHS
staff will identify issues and study questions which can be examined by
utilizing the data elements in common across the Demonstration Sites.
The utilization of agreed-upon measures which are in common across
Demonstration Sites provides the opportunity to compare intervention
effects for different populations in different geographic locations,
thereby enhancing the generalizability of results, and allows for
statistical analyses that assess the effects of multiple factors on
employment status outcomes.
Progress in employment is often characterized by episodes of
productive employment followed by unemployment. Therefore, a long-term
perspective is needed to appropriately assess outcomes of an
intervention. Successful applicants for this program of study will
include data collection over a period of at least 2 years, and a longer
time interval for data collection is encouraged.
The primary goal of this RFA is the determination of the
effectiveness of interventions. However, information on costs will be
valuable in informing policy decisions for resource allocations.
Effectiveness is defined as the improvement of positive outcomes and
the reduction of adverse outcomes, regardless of costs. An important
component in studying the value of an intervention is the determination
of the costs of the intervention. Because this is an initial
exploration of costs, the focus will be limited to actual direct
expenditures for employment intervention programs and employment site
activities. Costs unique to the evaluation component will not be
included in the analyses. Cost information from this demonstration
program may provide the basis for future studies of cost effectiveness
that would likely be expanded to incorporate financial costs, indirect
costs, and lost-opportunity costs.
Structure and Phases of the MultiSite Program: The study will
involve the cooperation of personnel from (1) a Coordinating Center,
(2) the Demonstration Sites, and (3) the CMHS staff.
Awards will be made for a project period of up to 5 years. For
planning and budgeting purposes, the study can be envisioned as
proceeding in the following three phases.
Phase I: Development of a collaborative study plan (common protocol);
development, refinement, and pilot testing of common methodological
procedures and instruments (baseline and outcome); training in the
common field procedures; examination of validity of proposed
instruments and development of a centralized database and coordinating
structure, intervention start up (months 1-6);
Phase II: Full implementation of service programs, identification and
enrollment of clients; ongoing data collection and evaluation
activities; interim data analyses (months 6-30);
Phase III: Phase-down of intervention programs; end enrollment of
clients in the study; complete follow-up data collection for enrolled
clients; conduct data analyses and produce reports and publications
(months 30-60).
Role of Demonstration Sites: Each Demonstration Site grantee, in
collaboration with the Federal staff and the Coordinating Center, will
have responsibility at their own site for service program planning and
implementation, client enrollment and follow up, data collection,
preliminary and final data analysis and interpretation, quality
control, and preparation of reports and publications. In addition, each
Demonstration Site grantee will participate in the development and
activities of the common protocol including providing data to the
Coordinating Center.
Role of the Coordinating Center: For the common protocol which will
be developed in the planning phase, the Coordinating Center will
provide overall study coordination, including data management and
analysis, training in common procedures, distribution of common
materials to all study sites, monitoring of data quality and analysis
of cost data collected by the Demonstration Sites. The Coordinating
Center will also coordinate the pilot testing of the common core
instruments, as agreed upon in the planning phase. CMHS staff will work
with and monitor the Coordinating Center. The Coordinating Center will
develop and maintain a common data repository, containing those data
elements collected by each Demonstration Site which will be used in the
common protocol.
Role of CMHS Staff: CMHS staff will be active participants in all
aspects of the cooperative agreements and will serve as collaborators
with project directors from the Demonstration Sites and the
Coordinating Center. CMHS staff have overall responsibility for
monitoring the conduct and progress of this program and will make
recommendations regarding continuance of the program. CMHS staff will
provide substantial input, in collaboration with the grantees, both in
the planning and conduct of this program.
Role of the Steering Committee: The Steering Committee will be
composed of the project director of the Coordinating Center, the
project directors from each of the Demonstration Sites, and CMHS staff.
In addition, for Demonstration Sites where the State mental health
authority is not the direct applicant, the State mental health
authority will be invited to be a participant as a voting member of the
committee.
All participating grantees will agree to abide by the common
protocol study design and policy recommendations developed by the
Steering Committee and any required CMHS approvals set forth in the
terms and conditions of this cooperative agreement.
Eligibility: Eligible applicants include States, political
subdivisions of states and nonprofit private agencies. Therefore, State
mental health authorities, as well as one or more of public
organizations in a State, such as units of State and local governments,
and nonprofit organizations such as community-based organizations,
universities, colleges and hospitals may be direct applicants.
Entities may apply for either and/or both types of awards
(Demonstration Site and/or Coordination Center).
Availability of Funds: It is estimated that approximately $2.3
million will be available to support approximately four to five awards
to Demonstration Sites and a Coordinating Center under this RFA in FY
95. For each of the 5 years, an average of approximately $300,000 per
year will be available for the Coordinating Center and an average of
$400,000 to $500,000 for each of the Demonstration Sites for each year.
It is anticipated that in years one and five, funding of the
Coordinating Center will be higher than in years two through four.
Funding for Demonstration Sites will be lower in years one and five,
and higher in years two through four. Actual funding levels will depend
upon the availability of appropriated funds.
(Note: CMHS is required by the Public Health Service Act to make
available 15 percent of the funds appropriated under Section 520A
for projects in rural areas.)
Period of Support: Support may be requested for a period of up to 5
years. Annual awards will be made subject to continued availability of
funds and progress achieved.
Applications Receipt Date and Review Schedule: The schedule for
receipt and review of applications under this announcement is as
follows:
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Earliest start
Receipt date IRG review Council review date
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Jan. 10, 1995.... March 1995....... May 1995........ June 1995.
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Consequences of Late Submission: Applications received after the
above receipt date will not be accepted and will be returned to the
applicant without review.
The DRG system requires that applications must be received by the
published application receipt date(s). However, an application received
after the deadline may be acceptable if it carries a legible proof-of-
mailing date assigned by the carrier and the proof-of-mailing date is
not later than one week prior to the deadline date. Private metered
postmarks are not accepted as proof of timely mailing. If the receipt
date falls on a weekend, it will be extended to the following Monday;
if the date falls on a national holiday, it will be extended to the
following work day.
Part III--Special Requirements, Review/Award Criteria and Contacts for
Additional Information
Letter of Intent: Organizations planning to submit an application
in response to this announcement are requested to submit a letter of
intent at least 30 days prior to the receipt date. Such notification is
used by the Center for Mental Health Services for purposes of review
and program planning. This letter is voluntary and does not obligate
the person/organization to submit an application. In addition, the
letter should be no longer than one page and should succinctly
indicate:
--The number and title of the RFA.
--The name of the potential applicant organization, city and state.
--The name and affiliation of the proposed project director, i.e., the
individual who will be assigned to coordinate the development and
conduct of the project.
--The overall scope of the proposed project, including a brief
description of the likely goals and objectives.
Letters of intent should be directed to: Barbara Silver, PhD,
Acting Director, Office of Extramural Policy and Review, Center for
Mental Health Services, 5600 Fishers Lane, Room 18C-07, Rockville,
Maryland 20857, Attn: RFA/Letter of Intent.
Coordination with Other Federal/Non-Federal Programs: Applicants
seeking support under this announcement are encouraged to coordinate
with other programs. Program coordination helps to better serve the
multiple needs of the patient/client population, maximize the impact of
available resources, and eliminate duplication of services. Applicants
should identify the coordinating organizations by name and address and
describe the process to be used for coordinating efforts. Letters of
commitment specifying the kind(s) and level of support from
organizations (both Federal and non-Federal) which have agreed to work
with the applicant must be attached to this application. CMHS will
consider an applicant's proposed coordination with other Federal/non-
Federal programs in its award decision-making process. (Please see
Award Criteria section.) A list of Federal programs that applicants may
coordinate with is included in the Application kit.
Single State Agency Coordination: Coordination with the Single
State Agency (SSA) for mental health is encouraged to ensure
communication, reduce duplication, and facilitate continuity. Therefore
applicants who are not State mental health authorities must include a
copy of a letter sent to the SSA briefly describing the grant
application. A list of SSAs can be found in the grant application kit.
If the target population falls within the jurisdiction of more than one
State, all representative SSAs should be involved.
Intergovernmental Review (E.O. 12372): Applications submitted in
response to this announcement are subject to the intergovernmental
review requirements of Executive Order 12372, as implemented through
DHHS regulations at 45 CFR Part 100. E.O. 12372 sets up a system for
State and local government review of applications for Federal financial
assistance. Applicants (other than federally recognized Indian Tribal
Authorities) should contact the State's Single Point of Contact (SPOC)
as early as possible to alert them to the prospective application(s)
and to receive any necessary instructions on the State process. For
proposed projects serving more than one State, the applicant is advised
to contact the SPOC of each affected State. A current listing of SPOCs
is included in the application kit. The SPOC should send any State
process recommendations to the following address: Barbara Silver, PhD,
Acting Director, Office of Extramural Policy and Review, Center for
Mental Health Services, 5600 Fishers Lane, Room 18C-07, Rockville, MD
20857, Attn: SPOC.
The due date for State process recommendations is no later than 60
days after the deadline date for the receipt of applications. The
Center for Mental Health Services does not guarantee to accommodate or
explain SPOC comments that are received after the 60-day cut-off.
Public Health System Reporting Requirements: This program is not
subject to the Public Health System Reporting Requirements.
Promoting Nonuse of Tobacco: Studies have clearly established that
the use of tobacco products increases mortality and morbidity, not only
for the primary users of these products but for those in close
proximity to the user. Statistics published by the National Cancer
Institute indicate that cigarette smoking and chewing of tobacco are
responsible for as many as 1,500 deaths per day in the United States.
Recent studies conducted by the Environmental Protection Agency
indicate that prolonged exposure to second-hand smoke significantly
increases the probability of developing heart and lung disease.
Consistent with its mission to protect and advance the physical and
mental health of the American people, it is the policy of PHS to
strongly encourage all recipients of the PHS grants to provide a smoke-
free work place and promote the nonuse of tobacco products. It is also
the policy of PHS to encourage those recipients which already have a
smoke-free work place and promote the nonuse of tobacco products to
continue such practices. Particular attention should be given to
avoiding exposure to secondary smoke by pregnant women and children.
Additionally, CMHS strongly encourages all cooperative agreement
applicants to implement policies and activities that promote the nonuse
of tobacco products by clients/patients as a goal of treatment.
Application Procedures: Completely separate applications must be
submitted for Demonstration Sites and for the Coordinating Center.
All applicants must use application form PHS 5161-1 (Rev. 7/92),
which contains Standard Form 424 (face page). Grant application kits
(including form PHS 5161-1 with Standard Form 424, complete application
procedures, and accompanying guidance materials for the narrative
approved under OMB No. 0937-0189) may be obtained from: Community
Support Program, Center for Mental Health Services, 5600 Fishers Lane,
Room 11C-22, Rockville, MD 20857, 301/443-3653.
Applicants must submit: (1) an original copy signed by the
authorized official of the applicant organization, with the appropriate
appendices; and (2) two additional, legible copies of the application
and all appendices to the Division of Research Grants, NIH. Center for
Mental Health Services Programs, Division of Research Grants, NIH,
Westwood Building, Room 240, 5333 Westbard Avenue, Bethesda, Maryland
20892*.
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*If an overnight carrier or express mail is used, the Zip Code
is 20816.
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Review Process: Applications submitted in response to this RFA will
be reviewed for technical merit in accordance with established PHS/
SAMHSA peer review procedures for grants.
Applications that are accepted for review will be assigned to an
Initial Review Group (IRG) composed primarily of non-Federal experts.
Notification of the IRG's recommendation will be sent to the applicant
upon completion of the initial review. In addition, the IRG
recommendations on technical merit of applications will undergo a
second level of review by the appropriate advisory council whose review
may be based on policy considerations as well as technical merit.
Applications may be considered for funding only if the advisory council
concurs with the IRG's recommendation for approval.
Review Criteria for Demonstration Site Applications: The points
noted in the parentheses for each criterion indicate the maximum number
of points the reviewers may assign to that criterion. These points will
be used to calculate a raw score for each application. The raw score
will be converted to the official priority score.
Significance of the Project (30)
Potential significance of the proposed project for
increasing the knowledge of effective employment interventions,
including original approaches and documenting the effectiveness of
established approaches.
Appropriateness of the applicant's proposed project to the
goals of this announcement.
Consistency of the proposed project relative to the
knowledge base of evaluating employment interventions.
Adequacy and Appropriateness of Project Plans (20)
In terms of the applicant's stated goals and objectives.
In terms of the project management plan, implementation
plan, and proposed staffing and resources.
In terms of cultural competency for all aspects of project
plans, addressing factors such as gender, age, ethnicity, and other
relevant characteristics.
Adequacy and Appropriateness of Evaluation Plans (35)
In terms of the adequacy to determine the effectiveness of
the intervention, including overall effectiveness, relative
effectiveness of components, and cost effectiveness.
In terms of the applicant's stated goals and objectives.
In terms of the proposed staffing and resources, project
management plan, and implementation plan.
In terms of cultural competency for all aspects of
evaluation plans, addressing factors such as gender, age, ethnicity,
and other relevant characteristics.
Appropriateness of Staffing, Project Organization, and
Resources (15)
Qualifications and experience of the project director and
other key personnel, including representation of appropriate cultural
groups in staff.
Adequacy of available resources (e.g., facilities,
equipment).
Capability and experience of the applicant organization
with multisite projects.
Adequacy of support for the project from other relevant
organizations.
Appropriateness of the proposed budget for each of the
requested years (the IRG may recommend either increases or decreases in
the budget based on their review of the application or on the adequacy
of the budget justification).
Review Criteria for Coordinating Center Applications:
Significance of the Project (20)
Understanding the issues and advantages in using a
multisite approach in the development of the common protocol, including
the logistics of convening program meetings.
Adequacy of plans for enhancing cooperation, and
preventing or ameliorating problems in cooperation among grantees.
Adequacy and Appropriateness of Evaluation Plans (40)
In terms of development of the common protocol, training,
an appropriate data base structure, security measures and procedures
for safeguarding of data.
In terms of data analysis based on the common protocol.
In terms of potential evaluation concerns unique to this
population and this type of program.
Appropriateness of Staffing, Project Organization, and Resources (40)
Qualifications and experience of the proposed staff in
similar multisite efforts.
Adequacy of the existing and proposed facilities and
resources.
Appropriateness of proposed budget for each of the
requested years.
Award Criteria: Applications recommended for approval by the
Initial Review Group and the CMHS Advisory Council will be considered
for funding on the basis of their overall technical merit as determined
through the review process. Other award considerations may include:
Availability of funds.
Coordination with other Federal/non-Federal programs.
For Demonstration Sites, complementarity of designs and
interventions, including factors such as ethnic groups, geographic
area, socioeconomic status, mental illness diagnosis.
In accordance 520A of the Public Health Service Act, no more than
10 percent of a grant may be expended for administrative expenses.
Contacts for Additional Information: Questions concerning program
issues may be directed to: Martha Ann Carey, PhD, RN, Community Support
Program, Center for Mental Health Services, 5600 Fishers Lane, room
11C-22, Rockville, MD 20857, (301) 443-3653.
Questions regarding grants management issues may be directed to:
Ms. Carole Edison, Grants Management Office, Center for Mental Health
Services, 5600 Fishers Lane, room 15C-05, Rockville, Maryland 20857,
(301) 443-4456.
Dated: August 24, 1994.
Richard Kopanda,
Acting Executive Officer, SAMHSA.
[FR Doc. 94-21290 Filed 8-29-94; 8:45 am]
BILLING CODE 4162-20-P
